Rabies: Pre-exposure and Post-Exposre Prophylaxis

Rabies: Pre-exposure and Post-Exposre Prophylaxis

Q. 1 Eight site rabies vaccine schedule is? 
 A

 0, 3, 7, 14, 28

 B 8-0-0-4-1-1
 C 8-0-4-0-1-1
 D 8-0-4-0-1-1
Q. 1 Eight site rabies vaccine schedule is? 
 A

 0, 3, 7, 14, 28

 B 8-0-0-4-1-1
 C 8-0-4-0-1-1
 D 8-0-4-0-1-1
Ans. C

Explanation:

8-0-4-0-1-1

REF: Park 20th edition page 243, 244, 245

  • Standard WHO Intramuscular regimen- 0,3,7,14,28 (one dose each at day 0,3,7,14,28)
  • Reduced Multisite Intramuscular regimen — 2-1-1 (two dose on each arm on day 0, one dose each at day 7 & 21)
  • Intradermal schedules : 2 site= 2  2 2 0 1  1 (At 2 sites on day 0,3,7 and single site on day 28, 90)
  • Intradermal schedules: 8 site= 8  0 4 0 1  1 (on 8 sites at day 0, on 4 sites at day 7, on one site at day 28 & 90)
  • Pre exposure prophylaxis — 0,7,28
  • Post exposure prophylaxis for those already immunized- 0,3,7

Q. 2

Louis Pasteur is NOT associated with?

 A

Vaccination of small pox

 B

Germ theory

 C

Vaccination of rabies

 D

Pasteurization

Q. 2

Louis Pasteur is NOT associated with?

 A

Vaccination of small pox

 B

Germ theory

 C

Vaccination of rabies

 D

Pasteurization

Ans. A

Explanation:

Works of Louis Pasteur

  • Germ theory of fermentation
  • Sterilisation techniques: steam steriliser, hot air oven and autoclaving
  • Vaccination against anthrax, rabies, cowpox and chickenpox.
  • Technique of pasteurization

Ref: Ananth Narayan 7/e, Page 5-7


Q. 3

Which of the following vaccine is developed by Louis Pasteur? 

 A

Anthrax

 B

Rabies

 C

Chicken cholera

 D

All of the above

Q. 3

Which of the following vaccine is developed by Louis Pasteur? 

 A

Anthrax

 B

Rabies

 C

Chicken cholera

 D

All of the above

Ans. D

Explanation:

Pasteur’s contributions:

  • Pasteur proved that all forms of life, even microbes, arose only from their like and not de novo.
  • Introduced techniques of sterilization and developed steam sterilizer, hot-air oven and autoclave
  • Developed vaccines against anthrax, rabies, chicken cholera
Ref: Textbook of Microbiology By Ananthanarayan And Paniker, 7th edition, Page 1.

Q. 4

A wild life officer comes to clinic for recieving prophylactic vaccine against rabies. How many doses of HDCV is needed for pre exposure prophylaxis of Rabies?

 A

1

 B

2

 C

3

 D

4

Q. 4

A wild life officer comes to clinic for recieving prophylactic vaccine against rabies. How many doses of HDCV is needed for pre exposure prophylaxis of Rabies?

 A

1

 B

2

 C

3

 D

4

Ans. C

Explanation:

Prophylaxis for rabies consist of administration of HDCV vaccine in a dose of either 1ml i.m/ 0.1ml intradermally on days 0, 7 and 28.

One month after the third injection serum titers of antibodies are checked and if the titre is less than 0.5 IU/ml booster doses should be administered until antibodies becomes demonstratable.


Q. 5

Vaccine prepared by embryonated Hen’s egg are 

 A

Measles

 B

Rabies

 C

Rubella

 D

Varicella

Q. 5

Vaccine prepared by embryonated Hen’s egg are 

 A

Measles

 B

Rabies

 C

Rubella

 D

Varicella

Ans. B

Explanation:

Ans. is ‘b’ i.e., Rabies 

.     Vaccines prepared in embrvonated Hen’s ettg :

–     Influenza (grown in allantoic cavity)      – Rabies

–     Yellow fever                                        – Mumps

.     Vaccines from Duck eeg

–     Non neural rabies vaccine


Q. 6

Neurological complications following Rabies vaccine is common with ‑

 A

HDCS Vaccine

 B

Chick embryo Vaccine

 C

Semple Vaccine

 D

Duck Egg Vaccine

Q. 6

Neurological complications following Rabies vaccine is common with ‑

 A

HDCS Vaccine

 B

Chick embryo Vaccine

 C

Semple Vaccine

 D

Duck Egg Vaccine

Ans. C

Explanation:

Ans. is ‘c’ i.e., Semple Vaccine

Rabies Vaccine

. Rabies vaccines are fluid or dried prepration of fixed virus grown in the neural tissues of rabbits, sheep, goats, mice or rats or in embryonated ducks egg or in cell cultures.

. Inactivation of virus is commonly done by treatment with formalin or R. Propiolactone (B.P.L.)

. Antirabies vaccine fall into two main categries.

. Neural Vaccines especially (Semple Vaccine) can cause neurological complications.

. Duck embryo Vaccine has less neuroparalytic complications, but can cause allergic reactions. Persons allergic to eggs, should not be given this vaccine.

. Cell culture vaccines are more potent, safer with fewer side effects and requre fewer injection than other vaccines.

Because of their potency and low cost ‘Second generation tissue culture vaccines are preferred.’


Q. 7

All of the following rabies vaccines are commercially available except –

 A

Killed sheep brain vaccine

 B

Human diploid cell vaccine

 C

Vero continous cell vaccine

 D

Recombinant glycoprotein

Q. 7

All of the following rabies vaccines are commercially available except –

 A

Killed sheep brain vaccine

 B

Human diploid cell vaccine

 C

Vero continous cell vaccine

 D

Recombinant glycoprotein

Ans. D

Explanation:

Ans. is ‘d’ i.e., Recombinant glycoprotein

Recombinant glycoprotein vaccines (Subunit vaccines) are still in experimental Stage.” – Anantnanarayan


Q. 8

Recommended vaccines for rabies ‑

 A

Semple

 B

Duck embryo vaccine

 C

Suckling mouse brain vaccine

 D

HDCV

Q. 8

Recommended vaccines for rabies ‑

 A

Semple

 B

Duck embryo vaccine

 C

Suckling mouse brain vaccine

 D

HDCV

Ans. D

Explanation:

Ans. is ‘d’ i.e., HDCV

.   A Cell culture vaccines ( HDCV, chick embryo fibroblast, vero continous cell line) are most potent safer with fewer side effects and require fewer injections than the others.

.   Because of their potency and low cost, second generation tissue culture vaccines ( chick embryo fibryoblast, vero continous cell line) are preferred.

.   So, the recommended vaccines for rabies are second generation tissue vaccines‑

•) Chick embryo fibroblast

ii) Vero continous cell line

.    As these vaccines are not given in option, preferred alternative is human diploid cell vaccine (HDCV).


Q. 9

Which anti-rabies vaccine has been recommended by WHO –

 A

Duck cell vaccine

 B

Chick fibroblast vaccine

 C

HDCV

 D

Sheep brain vaccine

Q. 9

Which anti-rabies vaccine has been recommended by WHO –

 A

Duck cell vaccine

 B

Chick fibroblast vaccine

 C

HDCV

 D

Sheep brain vaccine

Ans. B

Explanation:

Ans. is ‘b’ i.e., Chick fibroblast vaccine


Q. 10

Active immunisation following exposure is given most commonly for –

 A

Rabies

 B

Polio

 C

Plague

 D

Measles

Q. 10

Active immunisation following exposure is given most commonly for –

 A

Rabies

 B

Polio

 C

Plague

 D

Measles

Ans. A

Explanation:

Ans. is ‘a’ i.e., Rabies

Prevention of rabies

.       Prevention of rabies may be of following types

  1. Post exposure prophylaxis
  2. Preexposure prophylaxis
  3. Post-exposure treatment of persons who have been vaccinated previously.

Post exposure prophylaxis:

.   It is done after the bite of a rabid animal (mostly dog) in those persons who have not been vaccinated previously.

.   It includes : ‑

i)           Local treatment of the wound

ii)          Immunization

Note : In measles also, post exposure active immunization is given. But in question examinar has asked most common disease for post exposure prophylaxis, which is rabies.


Q. 11

The schedule of HDCV in rabies is –

 A

0, 3, 7, 10, 14, 28

 B

0, 3, 10, 30

 C

3, 7, 14, 16, 18

 D

0, 7, 14, 16, 18

Q. 11

The schedule of HDCV in rabies is –

 A

0, 3, 7, 10, 14, 28

 B

0, 3, 10, 30

 C

3, 7, 14, 16, 18

 D

0, 7, 14, 16, 18

Ans. A

Explanation:

Ans. is ‘a’ i.e. 0, 3, 7, 10, 14, 28

Schedules of vaccination for  post exposure prophylaxis

A. Intramuscular shedules

i)        Routine shedule -> 6 doses on 0, 3, 7, 14 and 28 days with a booster on day 90.

ii)      Abbreviated multisite schedule -> 2-1-1 regimen one dose is given in the right arm and one in left arm on day 0 after that one dose is given on day 7 and 21.

B. Intradremal schedules

i)        2-site intradermal schedule –> One dose of vaccine is given at each of two sites on days 0, 3 and 7 and at one site on days 28 and 90.

ii)      8-site intradermal schedule –> On day “0” vaccine is give at 8 sites, on day 7 vaccine is given at 4 sites, and on days 28 and 90 vaccine is given at one site.


Q. 12

What is the correct recommended schedule (on days) for post- exposure treatment of person who has been vaccinated for rabies previously with HDC ‑

 A

0, 3 and 7

 B

0, 3, 7 and 14

 C

0, 3, 7, 14 and 28

 D

0 and 3

Q. 12

What is the correct recommended schedule (on days) for post- exposure treatment of person who has been vaccinated for rabies previously with HDC ‑

 A

0, 3 and 7

 B

0, 3, 7 and 14

 C

0, 3, 7, 14 and 28

 D

0 and 3

Ans. A

Explanation:

Ans. is ‘a’ i.e., 0, 3 and 7

Post-exposure treatment of persons who have been vaccinated previously.

1) 3 doses of IM HDC vaccine on day 0, 3, 7 are recommended if : -) The patient’s antibody titre is not known.

ii) The antibody titre is known but it is less than 0.5 IU/ml.

iii) The bite is severe.

2) Only 2 doses are recommended if

i)         Antibody titre is more than 0.5 IU/ml.

ii)       The bite is not so severe.


Q. 13

Site for injection of cell culture rabies vaccine –

 A

Gluteus

 B

Subcutaneous

 C

Deltoid

 D

Anterior abdominal

Q. 13

Site for injection of cell culture rabies vaccine –

 A

Gluteus

 B

Subcutaneous

 C

Deltoid

 D

Anterior abdominal

Ans. C

Explanation:

Ans. is ‘c’ i.e., Deltoid

  • Rabies vaccine is given by either of two routes:‑

i) Intramuscular : Deltoid (most preferred) and/or thigh (in children < 2 years, anterolateral thigh is preferred). ii)Intradermal : Over deltoid and/or thigh.

  • In intramuscular regimen, injection is given into deltoid, while in intradermal regimen, injection is given intradermally over deltoid.

Q. 14

Post exposure active immunization can be done for 

 A

Rabies

 B

Measles

 C

Chloera

 D

a and b

Q. 14

Post exposure active immunization can be done for 

 A

Rabies

 B

Measles

 C

Chloera

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e., Rabies & ‘b’ i.e., Measles 

Post-exposure immunization

o Post exposure immunization is prophylactic immunization immediately after exposure to a pathogen, in order to prevent infection by the pathogen and the development of disease.

o Post exposure immunization is given for –

i) Varicella (chicken pox)                     iv) Measles

ii) Rabies                                         v) Tetanus

iii) Hepatitis                                     vi) Meningococcal meningitis


Q. 15

For post-exposure prophylaxis, dose of human rabies immunoglobulin is:           

September 2007

 A

10 IU/kg

 B

20 IU/kg

 C

30 IU/kg

 D

40 IU/kg

Q. 15

For post-exposure prophylaxis, dose of human rabies immunoglobulin is:           

September 2007

 A

10 IU/kg

 B

20 IU/kg

 C

30 IU/kg

 D

40 IU/kg

Ans. B

Explanation:

Ans. B: 20 IU/kg

Immunoglobulin should be given in a single dose of 20 IU per kg of body weight for human anti-rabies immunoglobulin, and 40 IU per kg of body weight for heterologous (equine) immunoglobulin.

Sensitivity to heterologous immunoglobulin must be determined before it is administered.

The physician should be prepared to deal with anaphylactic shock reactions.

Administration of rabies immunoglobulin (RIG) should be infiltrated into the depth of the wound and around the wound as much as anatomically feasible. Any remainder should be injected at an intramuscular site distant from that of vaccine inoculation e.g. into the anterior thigh/ gluteal region

Treatment should be started as early as possible after exposure, but in no case should it be denied to exposed persons whatever time interval has elapsed.


Q. 16

Rabies vaccine is prepared from which strain of virus:

September 2010

 A

Street virus

 B

Fixed Virus

 C

Wild virus

 D

All of the above

Q. 16

Rabies vaccine is prepared from which strain of virus:

September 2010

 A

Street virus

 B

Fixed Virus

 C

Wild virus

 D

All of the above

Ans. B

Explanation:

Ans. B: Fixed Virus

There are three main types of rabies vaccine:

  • Vaccines containing animal brain tissues

– Rabies virus phenol- or BPL-inactivated vaccines using as a substrate sheep or goat or brain. It contains nerve tissue.

– Rabies virus BPL-inactivated vaccine use as a substrate suckling brain mouse, with a decrease myelin content.

  • Avian vaccines using as a substrate duck embryo, are inactivated by b propiolactone, and purification is done by ultracentrifugation.
  • Cell-cultured vaccines

Human diploid cell culture vaccine (HDCV) is grown on human fibroblast, inactivated by b propiolactone.

  • Primary hamster kidney cells (PHKC) rabies vaccine is grown on hamster kidney cells, inactivated by formalin inactivated.
  • Purified chick embryo cells culture vaccine (PCEC) is inactivated by b propiolactone purified by ultracentrifugation
  • Purified Vero rabies vaccine (PVRV) is grown on Vero cells, inactivated by b -propiolactone and purified by ultracentrifugation.

Rabies vaccine adsorbed vaccine (RVA) uses a Kissling strain of rabies virus adapted to a diploid cell of fetal rhesus monkey lung fibroblast, inactivated by b-propiolactone, and containing alum phosphate.


Q. 17

Which of the following is not a part of management in grade III dog bite infected with rabies:

March 2009, September 2012

 A

Vaccination

 B

Stitch the wound with antibiotic coverage

 C

Wash with soap and water

 D

Administration of antirabies serum and vaccination

Q. 17

Which of the following is not a part of management in grade III dog bite infected with rabies:

March 2009, September 2012

 A

Vaccination

 B

Stitch the wound with antibiotic coverage

 C

Wash with soap and water

 D

Administration of antirabies serum and vaccination

Ans. B

Explanation:

Ans. B: Stitch the wound with antibiotic coverage

Wound cleansing and immunizations, done as soon as possible after suspect contact with an animal and following WHO recommendations, can prevent the onset of rabies in virtually 100% of exposures.

Recommended treatment to prevent rabies depends on the category of the contact:

  • Category I: touching or feeding suspect animals, but skin is intact
  • Category Il: minor scratches without bleeding from contact, or licks on broken skin
  • Category III: one or more bites, scratches, licks on broken skin, or other contact that breaks the skin; or exposure to bats Post-exposure care to prevent rabies includes cleaning and disinfecting a wound, or point of contact, and then administering anti-rabies immunizations as soon as possible.

Anti-rabies vaccine is given for Category II and III exposures.

Anti-rabies immunoglobin, or antibody, should be given for Category III contact, or to people with weaker immune systems.

Post-exposure treatment should start right away and only be stopped if the animal is a dog or cat and remains healthy after 10 days.


Q. 18

Which vaccine can cause adverse effects in persons with allergy to egg ‑

 A

Measles

 B

Rubella

 C

Rabies

 D

Mumps

Q. 18

Which vaccine can cause adverse effects in persons with allergy to egg ‑

 A

Measles

 B

Rubella

 C

Rabies

 D

Mumps

Ans. C

Explanation:

Ans. is ‘c’ i.e., Rabies

Duck embryo Vaccine has less neuroparalytic complications, but can cause allergic reactions. Persons allergic to eggs, should not be given this vaccine.

Rabies Vaccine

  • Rabies vaccines are fluid or dried prepration of fixed virus grown in the neural tissues of rabbits, sheep, goats, mice or rats or in embryonated ducks egg or in cell cultures.
  • Inactivation of virus is commonly done by treatment with formalin or 13. Propiolactone (B.P.L.) o Antirabies vaccine fall into two main categries.

Q. 19

A boy complained of unprovor de by a local dog in the community. The dog was lin. caught by the local animal authorities and appeared to be healthy. The most appropriate course of action would be:

 A

Give post-exposure prophylaxis to the bitten person with cell-culture derived vaccine

 B

Withhold vaccination, keep the dog under observation for ten days for signs of rabies

 C

Test the dog for rabies antibodies

 D

Immediately carry out euthanasia of the dog

Q. 19

A boy complained of unprovor de by a local dog in the community. The dog was lin. caught by the local animal authorities and appeared to be healthy. The most appropriate course of action would be:

 A

Give post-exposure prophylaxis to the bitten person with cell-culture derived vaccine

 B

Withhold vaccination, keep the dog under observation for ten days for signs of rabies

 C

Test the dog for rabies antibodies

 D

Immediately carry out euthanasia of the dog

Ans. A

Explanation:

Ans. a. Give post-exposure prophylaxis to the bitten person with cell-culture derived vaccine

A boy complained of unprovoked bite by a local dog in the community. The dog was later caught by the local animal authorities and appeared to be healthy. The most appropriate course of action would be give post-exposure prophylaxis to the bitten person with cell-culture derived vaccine.

-The vast majority of patients requiring anti-rabies treatment are those who were bitten by a suspected rabid animal. The aim of post-exposure prophylaxis is to neutralize the inoculated virus before it can enter the nervous system. Every instance of human exposure should be treated as a medical emergency. It is now well established that irrespective of the class of wound, the combined administration of a single does of rabies immunoglobulin if indicated, with a course of vaccine, together with local treatment of the wound is the best specific prophylactic treatment after exposure of a man to rabies.”

Post-Exposure Prophylaxis

  • The vast majority of patients requiring anti-rabies treatment are those who were bitten by a suspected rabid animal.
  • Aim: To neutralize the inoculated virus before it can enter the nervous systemQ.
  • Every instance of human exposure should be treated as a medical emergency.
  • It is now well established that irrespective of the class of wound, the combined administration of a single does of rabies immunoglobulin if indicated, with a course of vaccine, together with local treatment of the wound is the best specific prophylactic treatment after exposure of a man to rabiesQ.
  • Since their development more than four decades ago, concentrated and purified cell-culture vaccine (CCV) and embryonated egg-based vaccine (EEV) have proved to be effective and safe in preventing rabies°. These vaccines are intended for pre-exposure as well as post-exposure prophylaxis.

 

Categories of contact with suspected Rabid anima                              

Post-exposure prophylaxis measure

 

Touching or feeding animals Licks on intact skin

NoneQ

 

Nibbling of uncovered skin

Immediate vaccination and local

 

Minor scratches or abrasions without bleeding

treatment of the woundQ

 

Single or multiple transdermal bites or scratches

Immediate vaccination and

 

Licks on broken skin

administration of rabies immunoglobulin

 

Contamination of mucous membrane with saliva from licks

and local treatment of the woundQ

 

Contact with bats

 

Q. 20

Cat bites in child treatment – false is

 A

Cleaning the wound thoroughly

 B

Puncture wound most common

 C

May require rabies vaccination

 D

All of above

Q. 20

Cat bites in child treatment – false is

 A

Cleaning the wound thoroughly

 B

Puncture wound most common

 C

May require rabies vaccination

 D

All of above

Ans. D

Explanation:

Ans. is `d’ i.e., All of above


Q. 21

Antiserum is available for passive immunization against ‑

 A

Rabies

 B

Typhoid

 C

Meales

 D

Mumps

Q. 21

Antiserum is available for passive immunization against ‑

 A

Rabies

 B

Typhoid

 C

Meales

 D

Mumps

Ans. A

Explanation:

Ans. is ‘a’ i.e., Rabies

For passive immunization

A.   Antiserum

  • Rabies
  • Tetanus
  • Diphtheria

B.   Human normal immunoglobulins

  • Rabies
  • Tetanus
  • Hepatitis A
  • Measles
  • Mumps

C.  Human specific immunoglobulins

  • Diphtheria
  • Hepatitis B
  • Varicella


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